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Account Type

Account Details

Confirmation

New Customer Application

We looking forward to building a beautiful business partnership with you! Before we do that, we will need a few
days to review your new customer application. To check on the status of your application, please feel free to give
our Wizards of WOW a call anytime at 1 800 263 2322.

About You

Company Name *

Founded

First Name *

Initial

Last Name *

Phone # *

Fax #

Email Address *

Website

Acknowledgement Email (if different from Email)

Billing Info

Street Address *

Unit

City / Town *

Country: Province / State *

Zip / Postal Code *

Phone Number

Hours Of Operation

Invoice Email (if different from Email)

Statement Email (if different from Invoice Email)

US Federal Tax ID (9 digits) *

Resale # *

Payment Preferences *

Credit Card

Terms

Thank you for choosing to pay with a credit card. A Roma Team member will contact you shortly to complete your application.

Thank you for choosing to pay with terms. A Roma Team member will contact you shortly to complete your application.

Trade Reference #1

Company Name *

Phone # *

Contact Name *

Fax #

Address *

Trade Reference #2

Company Name *

Phone # *

Contact Name *

Fax #

Address *

Trade Reference #3

Company Name *

Phone # *

Contact Name *

Fax #

Address *

Store Locations

Street Address *

Unit

City / Town *

Country: Province / State *

Zip / Postal Code *

Phone Number

Hours Of Operation

Business Details

Type Of Business

Custom Framer

Gallery

Interior Design

Furniture Store

Artist

Hospitality

Lifestyle & Home Décor Store

Gift & Accessory Store

Other

If Other Please Specify

Do You Have a Storefront?

Yes
No

Annual Sales Volume *

Do you Display Corner Samples?

Yes
No

Number Of Store Locations

Do You Offer Custom Framing?

Yes
No

Additional Notes

I consent to the obtaining of bank/credit and/or personal information as may be required at any time in connection with the credit hereby applied for or renewal or extension hereof and to the disclosure of the credit information concerning me and/or my company to any credit reporting agency or to any person with the undersigned who has or purports to have financial relations. I further acknowledge that " Title of Goods " remains with the credit grantor even though goods may be in transit and/or on customer's premises ( in case of resale ), until payment has been received in full. I am obliged to inform Roma in writing of any changes in the legal
name and form of the company. Failure to do so will permit Roma to continue to deal with the undersigned in the form as noted on this credit application. I have read and agreed to abide by Roma's current Terms & Conditions of Sales. I hereby certify that the information contained in this application is true and correct. All information, including credit card numbers, will be kept confidential and not shared with third parties.